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1、Outline,Discuss simple steps in analyzing ABGs Calculate the anion gap Calculate the delta gap Differentials for specific acid-base disorders,Steps for ABG analysis,What is the pH? Acidemia or Alkalemia? What is the primary disorder present? Is there appropriate compensation? Is the compensation acu
2、te or chronic? Is there an anion gap? If there is a AG check the delta gap? What is the differential for the clinical processes?,Normal Values,Step 1:,Look at the pH: is the blood acidemic or alkalemic? EXAMPLE : 65yo M with CKD presenting with nausea, diarrhea and acute respiratory distress ABG :AB
3、G 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.1 ACIDMEIA OR ALKALEMIA ?,EXAMPLE ONE,ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.1 Answer PH = 7.23 , HCO3 7 Acidemia,Step 2: What is the primary disorder?,EXAMPLE,ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3
4、 7/BUN 119/ Cr 5. PH is low , CO2 is Low PH and PCO2 are going in same directions then its most likely primary metabolic will check to see if there is a mixed disoder.,Step 3-4: Is there appropriate compensation? Is it chronic or acute?,Respiratory Acidosis Acute: for every 10 increase in pCO2 - HCO
5、3 increases by 1 and there is a decrease of 0.08 in pH MEMORIZE Chronic: for every 10 increase in pCO2 - HCO3 increases by 4 and there is a decrease of 0.03 in pH Respiratory Alkalosis Acute: for every 10 decrease in pCO2 - HCO3 decreases by 2 and there is a increase of 0.08 in PH MEMORIZE Chronic:
6、for every 10 decrease in pCO2 - HCO3 decreases by 5 and there is a increase of 0.03 in PH,Step 3-4: Is there appropriate compensation? Is it acute or chronic ?,Metabolic Acidosis Winters formula: pCO2 = 1.5HCO3 + 8 2 MEMORIZE If serum pCO2 expected pCO2 - additional respiratory acidosis Metabolic Al
7、kalosis For every 10 increase in HCO3 - pCO2 increases by 6,EXAMPLE,ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5. Winters formula : 17= 1.5 (7) +8 = 18.5 So correct compensation so there is only one disorder Primary metabolic,Step 5: Calculate the anion gap,AG = Na Cl HCO3 (norm
8、al 12 2) AG corrected = AG + 2.54 albumin If there is an anion Gap then calculate the Delta/delta gap (step 6). Only need to calculate delta gap (excess anion gap) when there is an anion gap to determine additional hidden metabolic disorders (nongap metabolic acidosis or metabolic alkalosis) If ther
9、e is no anion gap then start analyzing for non-anion acidosis,EXAMPLE,Calculate Anion gap ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5/ Albumin 4. AG = Na Cl HCO3 (normal 12 2) 123 97 7 = 19 No need to correct for albumin as it is 4,Step 6: Calculate the different needed formula
10、s,Delta gap = (actual AG 12) + HCO3 Adjusted HCO3 should be 24 (+_ 6) 18-30 If delta gap 30 - additional metabolic alkalosis If delta gap additional non-gap metabolic acidosis If delta gap 18 30 - no additional metabolic disorders,EXAMPLE : Delta Gap,ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3
11、 7/BUN 119/ Cr 5/ Albumin 4. Delta gap = (actual AG 12) + HCO3 (19-12) +7 = 14 Delta gap additional non-gap metabolic acidosis So Metabolic acidosis anion and non anion gap,Metobolic acidosis: Anion gap acidosis,EXAMPLE: WHY ANION GAP?,65yo M with CKD presenting with nausea, diarrhea and acute respi
12、ratory distress ABG :ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.1 So for our patient for anion gap portion its due to BUN of 119 UREMIA But would still check lactic acid,Nongap metabolic acidosis,For non-gap metabolic acidosis, calculate the urine anion gap UAG = UNA + UK UCL
13、If UAG0: renal problem If UAG0: nonrenal problem (most commonly GI),EXAMPLE : NON ANION GAP ACIDOSIS,65yo M with CKD presenting with nausea, diarrhea and acute respiratory distress ABG :ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.1 Most likely due to the diarrhea,Metabolic alka
14、losis,Calculate the urinary chloride to differentiate saline responsive vs saline resistant Must be off diuretics in order to interpret urine chloride,Respiratory Alkalosis,Respiratory Acidosis,Steps for ABG analysis,What is the pH? Acidemic or Alkalemic? What is the primary disorder present? Is there appropriate compensation? Is the compensation acute or chronic? Is there an anion gap? If there is a AG, what is the delta gap? What is the differential for the clinical processes?,